Initial Oral Therapy for Severe Hypertension in a Patient Not Already Receiving Anti-Hypertensive Therapy

Initial Oral Therapy for Severe Hypertension in a Patient Not Already Receiving Anti-Hypertensive Therapy

Clinical setting	Drug therapy
Phaeochromocytoma suspected (see Chapter94)	Labetalol 100–200 mg 12-hourly PO
Renal artery stenosis suspected (see Table55.6)	Amlodipine ^* 5–10 mg daily PO plus Bisoprolol 2.5–5 mg daily PO
Heart failure (see Chapter48)	Amlodipine^* 5–10 mg daily PO plus Furosemide 20–40 mg daily PO
Other patients	Patients aged <55: ACE-inhibitor Patients aged ≥55, or Afro-Caribbean origin of any age: calcium-channel blocker or thiazide (if fluid retention present)

Clinical setting

Drug therapy

Phaeochromocytoma suspected

(see Chapter94)

Labetalol 100–200 mg 12-hourly PO

Renal artery stenosis suspected

(see Table55.6)

Amlodipine ^* 5–10 mg daily PO plus

Bisoprolol 2.5–5 mg daily PO

Heart failure

(see Chapter48)

Amlodipine^* 5–10 mg daily PO plus

Furosemide 20–40 mg daily PO

Other patients

Patients aged <55: ACE-inhibitor

Patients aged ≥55, or Afro-Caribbean origin of any age: calcium-channel blocker or thiazide (if fluid retention present)

^*Nifedipine MR should be co-administered with amlodipine for the first three days of treatment with amlodipine (as amlodipine has a large volume of distribution, and is therefore of limited efficacy during this period).

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Table 55.5